Practicing without completion of residency

[rdoctor1234]

Hello!

I was terminated from a PGY3 internal medicine position two years ago and have had difficulty finding either a PGY2 or PGY3 position in order to finish. I was advised that I would likely need to apply again as a PGY1. I am unsure that I would like to complete another three years of residency as I need to move on with life and have another job in biotechnology. I do, however, want to practice medicine, also, likely part-time.

I heard that it is possible to practice at VA hospitals after completing a PGY1 internal medicine year only. Is this true and if so what is the process? Is obtaining a license necessary and if so what is the process of obtaining a license without having completed residency? Are VA hospitals the only institutions at which I would be able to work? What other considerations do you suggest I weigh / understand as I proceed down this path?

Thank you kindly,

RDoctor1234.

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[gutonc]

Hello!

I was terminated from a PGY3 internal medicine position two years ago and have had difficulty finding either a PGY2 or PGY3 position in order to finish. I was advised that I would likely need to apply again as a PGY1. I am unsure that I would like to complete another three years of residency as I need to move on with life and have another job in biotechnology. I do, however, want to practice medicine, also, likely part-time.

I heard that it is possible to practice at VA hospitals after completing a PGY1 internal medicine year only. Is this true and if so what is the process? Is obtaining a license necessary and if so what is the process of obtaining a license without having completed residency? Are VA hospitals the only institutions at which I would be able to work? What other considerations do you suggest I weigh / understand as I proceed down this path?

Thank you kindly,

RDoctor1234.

You need a license first. If you're an AMG, you can get licensed almost everywhere with 2y of training. If you're an IMG, you can licensed almost nowhere with 2y of training.

VA, IHS and BOP all just require any state license to practice there. Many (most?) VAs want/require BC/BE these days. Not all of course, there are some very rural ones and remote clinics that may take you.

 

[Apollyon]

Indian Health Service, Bureau of Prisons, board certified, board eligible

And, pro tip: contact the board of medicine for any state or territory. Every one - from Alabama to Wyoming, from Maine to the Northern Marianas Islands - has a website with exactly what you need for a license.

 

[NotAProgDirector]

All state license summarized here: FSMB | State Specific Requirements for Initial Medical Licensure

 

[shaggybill]

It's possible, but you're options are greatly limited as others here already mentioned. With the exception of cash-only practices (cosmetics, HRT, etc), billing insurance is where the revenue comes from. Insurance typically wants to see BE/BC. The exception there may be if you're working under a "supervising physician," but I'm assuming doing so means less pay for you and finding someone who's desperate enough to hire a "higher liability" employee that requires extra work just to get them started. In addition to what's been mentioned above, some state prisons don't require BC/BE. If you're only doing it part time, I'm assuming you don't need benefits/health insurance. In that case, look for locums positions on locums websites. Depending on the state, a lot of prison work is posted as locums.

 

[mvenus929]

Being terminated so late in residency is a huge red flag, and you'll need some sort of support from your home program in order to get a position anywhere. If you don't have those, you're not going to get very far.

 

[robellis]

How do you get terminated as a pgy3?

 

[j4pac]

Logically...I can’t envision a scenario where a PGY-2 or PGY-3 program would take you. That’s fantasy. You’d be very fortunate to repeat PGY-1, though I’m doubtful that would happen. It would really take a program losing a PGY-1 before internship from one of those IMG mill programs. You’re trying to find someone as desperate as you are. But that really is your best option.

You can get an unrestricted medical license in a number of states with just an internship. But a career job? That is very suspect. You’d more than likely be looking at very underserved situations, again desperate employer. I highly doubt the VA qualifies. And the bubble may burst on your ability to practice with just an internship. I’d definitely look into this as a short-term option.

 

[j4pac]

As the original poster, and as advice for anyone else reading who may be in a similar situation, I can write with confidence that this is simply untrue.

What exactly is untrue?

 

[j4pac]

Just be careful when you reply to posts on this site, especially from those asking for genuine advice. I am sure many post gratuitously, however, some, such as me, post seriously and are grateful for thoughtful and real answers.

When you respond with strong statements that are unsupported by evidence or by substantial personal experience, the quality of the site deteriorates.

In contrast, posts like those from BacktotheBasics are thoughtful, strong, and helpful.

I give nothing but my personal opinion based on my own personal experiencing mentoring over 15 years. You not liking my strong statements is a you problem.

 

[j4pac]

Given my situation, the following ideas that your wrote are untrue:

1) Repeating PGY1 is highly unlikely.

I think you could get a PGY-1. Though it will be a challenge, as you are now a higher risk applicant than the many unmatched IMG applicants. You have washed out...if I was a PD I’d rather give the spot to someone without that track record.

2) Repeating PGY1 would occur only at an "IMG mill program" where a PGY1 is lost prior to internship.

You are a very high risk applicant. You don’t seem to get it. You should be desperate at this point to get A spot. But it seems like you are just focusing in on PGY-2 and PGY-3. If you really want to be a board certified physician one day...you should be willing to do what it takes. You seem to think you’re above it...and it could very well be your demise.

3) Residency is unlikely an option and that only a short-term option from a desperate employer is a possibility.

Residency is easily your best option...but getting a seat will be incredibly difficult. Washing out of a lower residency program is bad. I’d highly question the decision making of a PD that takes you in for either PGY-2 or 3. I don’t think you appreciate the challenge you are up against and I want to get that across to you...and if having strong wording is what takes then that’s fine by me. The VA is not desperate for physicians that are not board eligible. You absolutely should be looking at working with an unrestricted license...but I’d definitely do what it takes to get board certified...as that clearly opens significantly more options down the road. We may have a day in the future that you cannot with in this country without residency completion.

 

[j4pac]

Someone asked earlier why I was terminated. I was terminated because I refuse to submit to *******es like j4pac. In no industry other than medicine can someone make incorrect statements and continue to swing their dick like they own the place, simply because they have been around for "15 years."

It's sad, causes a lot of mistakes in medicine. It's likely also temporary, as it clearly undermines the profession, but change in medicine proceeds at detrimentally slow pace.

J4Pac, your "personal opinion" is wrong, regardless of how many years you've been mentoring. The original question asked for advice, which should be addressed with facts where possible and only opinion if qualified by a statement suggesting it's nondefinitive nature. I dislike your strong statement because not only does it not add to the conversation, it detracts, by adding incorrect bull**** that you mused and decided to post. You, J4Pac, are the problem with medicine and I unfortunately am the victim, because I call out your bull****.

You have all the answers. So why are you here? For people to pat you on the back and give a false sense of your reality?

 

[shaggybill]

We may have a day in the future that you cannot with in this country without residency completion.

Given the projected physician shortage, hopefully that won't occur any time soon. And if it does, I would also hope the law grandfathers in those who are already practicing. I say this as a biased non-BC doc who only finished around 2 years of residency (voluntarily).

 

[Dave1980]

Given the projected physician shortage, hopefully that won't occur any time soon. And if it does, I would also hope the law grandfathers in those who are already practicing. I say this as a biased non-BC doc who only finished around 2 years of residency (voluntarily).

Not sure how someone with less than 3 years of residency thinks they are qualified for independent practice. SMH

 

[j4pac]

Given the projected physician shortage, hopefully that won't occur any time soon. And if it does, I would also hope the law grandfathers in those who are already practicing. I say this as a biased non-BC doc who only finished around 2 years of residency (voluntarily).

I think that you are likely correct. But certainly there’s some risk there.

 

[shaggybill]

Not sure how someone with less than 3 years of residency thinks they are qualified for independent practice. SMH

That is probably true in most areas of medicine. But not all.

 

[d2305]

The OP must be an IMG and has no recourse.

 

[ThoracicGuy]

The OP can always look into something like Occupational Medicine. That only requires completion of a PGY1 year somewhere and would give a path to board certification.

As @j4pac said, there is basically zero chance of getting a IM PGY3 spot anywhere. PGY2 spots would be rare to find in the OPs situation. PGY1 spots are the best bets. If @rdoctor1234 wants to have a job as a physician, they should be willing to start over as a PGY1. If not, go do that biotech job and close the door to medicine.

 

[BoardingDoc]

The OP can always look into something like Occupational Medicine. That only requires completion of a PGY1 year somewhere and would give a path to board certification.

As @j4pac said, there is basically zero chance of getting a IM PGY3 spot anywhere. PGY2 spots would be rare to find in the OPs situation. PGY1 spots are the best bets. If @rdoctor1234 wants to have a job as a physician, they should be willing to start over as a PGY1. If not, go do that biotech job and close the door to medicine.

Agree with this and much of the above. Also, looking through the posts above it seems like everytime @rdoctor1234 posts, it's being removed for being inflammatory/directly attacking people whose opinion they don't agree with. I don't anticipate that they'll be meaningfully responding again... maybe the thread is done.

 

[j4pac]

Agree with this and much of the above. Also, looking through the posts above it seems like everytime @rdoctor1234 posts, it's being removed for being inflammatory/directly attacking people whose opinion they don't agree with. I don't anticipate that they'll be meaningfully responding again... maybe the thread is done.

He/she pretty much confirmed that he/she washed out because he/she is a hot head.

 

[BoardingDoc]

He/she pretty much confirmed that he/she washed out because he/she is a hot head.

Umm, yeah. Posted ~3 yrs ago.

It is our recommendation that [redacted] receive an independent psychiatric evaluation, preferably by the [name of organization redacted], but at the very least by a psychiatrist approved by the Panel. This evaluation should be accompanied by the recommended treatment before final termination of his position is effective. It is also our finding that [redacted] has not successfully improved his deficiencies as outline in [redacted]'s letter notifying [redacted] of his probation. Had the psychotherapy been mandated, the Panel would have recommended termination.

[Redacted]'s continuance in the [redacted] Residency Program represents a danger to patient safety. We concur with [redacted]'s decision to remove him from his residency training on [date redacted].

The panel recommends that [redacted] should be considered suspended from the [redacted] Residency Program until the recommended psychiatric evaluation is completed.

All Panel members have read and agree with this report.

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Is the resident terminated or is a decision regarding termination pending the result of the psychiatric evaluation?

Followed by:

“... deficits in communication and interpersonal skills, professionalism, and accepting feedback.”

when asked "what were they fired for."

Thread in question: Can some interpret this letter?

 

[ThoracicGuy]

Umm, yeah. Posted ~3 yrs ago.


Followed by:


when asked "what were they fired for."

Thread in question: Can some interpret this letter?

Of course this will always come out in the end... The OP in these cases would be better off just admitting the truth from the beginning...

 

[Splenda88]

You need a license first. If you're an AMG, you can get licensed almost everywhere with 2y of training. If you're an IMG, you can licensed almost nowhere with 2y of training.

VA, IHS and BOP all just require any state license to practice there. Many (most?) VAs want/require BC/BE these days. Not all of course, there are some very rural ones and remote clinics that may take you.

~34 states will license you after 1-yr post grad training if you are an AMG. Georgia will if you graduated from St Georges University. I believe there are a couple of states that will after 2-yr postgrad training if you are an IMG.

 

[Splenda88]

Logically...I can’t envision a scenario where a PGY-2 or PGY-3 program would take you. That’s fantasy. You’d be very fortunate to repeat PGY-1, though I’m doubtful that would happen. It would really take a program losing a PGY-1 before internship from one of those IMG mill programs. You’re trying to find someone as desperate as you are. But that really is your best option.

You can get an unrestricted medical license in a number of states with just an internship. But a career job? That is very suspect. You’d more than likely be looking at very underserved situations, again desperate employer. I highly doubt the VA qualifies. And the bubble may burst on your ability to practice with just an internship. I’d definitely look into this as a short-term option.

It's difficult but it's not as difficult to get a job as most in SDN think if OP can get a license. My friend has been working with a GP license for close to 7 yrs now making essential what many PCP make (~200k/yr).

I don't think OP will be able to get a job at any VA...

 

[Splenda88]

Not sure how someone with less than 3 years of residency thinks they are qualified for independent practice. SMH

The same way NP with 500-1000 hrs of training are... Same for PA with their 2000 hrs.

 

[j4pac]

It's difficult but it's not as difficult to get a job as most in SDN think if OP can get a license. My friend has been working with a GP license for close to 7 yrs now making essential what many PCP make (~200k/yr).

I don't think OP will be able to get a job at any VA...

Back in my Navy days I got a job moonlighting in urgent care that paid about $100/hour. You can get a job...but it puts significant restrictions upon you. And liability is high.

 

[Dave1980]

The same way NP with 500-1000 hrs of training are... Same for PA with their 2000 hrs.

oh you mean the same people who the AMA and almost all doctors say are underqualified to have independent practice? Good argument.

 

[OrthoTraumaMD]

Of course this will always come out in the end... The OP in these cases would be better off just admitting the truth from the beginning...

To be fair, the interaction between him and @j4pac made it pretty clear...

Op: please help me and give me advice
J4pac: here is advice
Op: how dare you tell me something I don’t want to hear? The problem with medicine is toxic people like j4pac! None of this is my fault, it’s them and people like them! (Proceeds to curse j4pac out)

The comical lack of insight and any sense of personal responsibility, as well as the blowup and name calling, makes me glad this person was fired and hopefully stayed fired. yikes. a good example of why professionalism is a competency.